Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Otolaryngol Head Neck Surg. 2024 May;170(5):1319-1330. doi: 10.1002/ohn.672. Epub 2024 Feb 14.
Patients treated for oropharyngeal cancer (OPC) have historically demonstrated high feeding tube rates for decreased oral intake and malnutrition. We re-examined feeding tube practices in these patients.
Retrospective analysis of prospective cohort from 2015 to 2021.
Single-institution NCI-Designated Comprehensive Cancer Center.
With IRB approval, patients with new oropharyngeal squamous cell cancer or (unknown primary with neck metastasis) were enrolled. Baseline swallowing was assessed via videofluoroscopy and Performance Status Scale for Head and Neck Cancer (PSSHN). G-tubes or nasogastric tubes (NGT) were placed for weight loss before, during, or after treatment. Prophylactic NGT were placed during transoral robotic surgery (TORS). Tube duration was censored at last disease-free follow-up. Multivariate regression was performed for G-tube placement (odds ratio [OR] [95% confidence interval [CI]) and removal (Cox hazard ratio, hazard ratio [HR] [95% CI]).
Of 924 patients, most had stage I to II (81%), p16+ (89%), node-positive (88%) disease. Median follow-up was 2.6 years (interquartile range 1.5-3.9). Most (91%) received radiation/chemoradiation, and 16% received TORS. G-tube rate was 27% (5% after TORS). G-tube risk was increased with chemoradiation (OR 2.78 [1.87-4.22]) and decreased with TORS (OR 0.31 [0.15-0.57]) and PSSHN-Diet score ≥60 (OR 0.26 [0.15-0.45]). G-tube removal probability over time was lower for T3 to T4 tumors (HR 0.52 [0.38-0.71]) and higher for PSSHN-Diet score ≥60 (HR 1.65 [1.03-2.66]).
In this modern cohort of patients treated for OPC, 27% received G-tubes-50% less than institutional rates 10 years ago. Patients with preserved baseline swallowing and/or those eligible for TORS may have lower G-tube risk and duration.
接受口咽癌（OPC）治疗的患者因口腔摄入减少和营养不良而存在较高的置管率。我们重新检查了这些患者的置管情况。
对 2015 年至 2021 年期间前瞻性队列的回顾性分析。
单一机构 NCI 指定的综合癌症中心。
在获得机构审查委员会批准的情况下，招募新诊断的口咽鳞状细胞癌患者或（原发灶不明伴颈部转移）患者。通过视频透视和头颈部癌的表现状态量表（PSSHN）评估基线吞咽情况。在治疗前、治疗期间或治疗后因体重减轻而放置胃造口管或鼻胃管（NGT）。在经口机器人手术（TORS）期间预防性放置 NGT。管的持续时间截止到最后一次无疾病随访。对胃造口管放置（比值比 [OR] [95%置信区间 [CI]）和移除（Cox 风险比，风险比 [HR] [95% CI]）进行多变量回归。
924 例患者中，大多数为 I 期至 II 期（81%）、p16+（89%）、淋巴结阳性（88%）疾病。中位随访时间为 2.6 年（四分位距 1.5-3.9）。大多数（91%）接受了放疗/放化疗，16%接受了 TORS。胃造口管的使用率为 27%（TORS 后为 5%）。化学放射治疗增加了胃造口管的风险（OR 2.78 [1.87-4.22]），TORS（OR 0.31 [0.15-0.57]）和 PSSHN-Diet 评分≥60（OR 0.26 [0.15-0.45]）降低了胃造口管的风险。随着时间的推移，T3 至 T4 肿瘤的胃造口管移除概率较低（HR 0.52 [0.38-0.71]），PSSHN-Diet 评分≥60 的胃造口管移除概率较高（HR 1.65 [1.03-2.66]）。
在这个现代的口咽癌患者队列中，27%的患者接受了胃造口管治疗，比 10 年前机构治疗率低 50%。具有基线吞咽功能保留和/或有资格接受 TORS 的患者，胃造口管的风险和持续时间可能较低。
